Type 2 diabetes is a chronic (long-term) condition that affects how your body processes glucose (blood sugar). Although type 2 diabetes can’t be cured, effective treatments are available to help control blood sugar, slow disease progression, and prevent serious complications.

For some people, early-stage diabetes can be reversed with treatment and lifestyle changes, especially a low-carbohydrate diet and regular exercise. Treatment and medication recommendations for type 2 diabetes consider factors such as your blood sugar levels, how well it’s being controlled, your age, overall health, and any other medical conditions you have or medications you may be using.

Research shows that many people with type 2 diabetes don’t take their medications regularly or as directed, and at least 45 percent don’t get their blood glucose under control. When diabetes medications are skipped or underused, blood sugar levels can increase, which can cause ongoing damage to the body. Over time, this can lead to more symptoms and complications, including vision loss, kidney damage, and foot amputation. Untreated hyperglycemia (high blood sugar) can also lead to increased risks of heart attack, stroke, and cardiovascular disease (disease of the heart and blood vessels often called heart disease).

It’s essential to keep taking your medications as prescribed, even if you’re feeling better. If side effects bother you, talk to your doctor about switching medications or timing them differently. If you have trouble remembering to take your type 2 diabetes medications, try setting reminders on your phone or consider asking for support from family members.

How Is Type 2 Diabetes Managed?

Type 2 diabetes management involves a combination of lifestyle changes and medical treatments. The main goals are to control blood sugar levels, prevent complications, and improve overall health. Key steps include:

• Eating healthy
• Engaging in regular physical activity
• Quitting smoking
• Managing unwanted weight gain
• Using medication or insulin therapy, if necessary
• Monitoring blood sugar consistently
• Having regular checkups with health care providers

Monitoring Blood Sugar

Regularly testing blood sugar at home is an important part of managing type 2 diabetes. This step helps you and your doctor understand how well your treatment plan is working.

The most important time to test your blood sugar is early in the morning, with target levels typically between 80 and 130 milligrams per deciliter. Your doctor may recommend a slightly higher target if you’re prone to hypoglycemia (low blood sugar). It’s also helpful to test your blood sugar two hours after meals to ensure it doesn’t rise too high. The target for this reading is usually 180 milligrams per deciliter or lower.

If you’re taking your medications as directed but your blood glucose isn’t under control, your doctor can adjust your medicine’s timing or dosage so it’s more effective. You may also be a candidate for newer options to measure your blood sugar, such as continuous glucose monitoring, which provides ongoing insights into your levels throughout the day.

Types of Treatments for Type 2 Diabetes

Lifestyle Changes

Lifestyle changes, including weight loss, healthy eating, and increased physical activity, are considered first-line treatments for managing type 2 diabetes. These changes can significantly slow the progression of insulin resistance and support overall health.

• Weight loss — Shedding excess weight may lower inflammation in the body, which is thought to contribute to insulin resistance.
• Exercise — Physical activity helps the body use insulin more effectively, lowers blood sugar levels, and supports weight management. Aim for a mix of cardiovascular activities (such as walking, running, or cycling) and resistance (strength) training to maintain muscle mass.
• Healthy eating — A balanced diet with fewer carbohydrates helps stabilize blood sugar levels. Reducing intake of foods high in saturated fats may also help improve cholesterol and triglyceride levels. Aim to eat nutritious meals and healthy snacks.

Research suggests that a low-calorie diet may lead to type 2 diabetes remission, meaning that blood sugar levels return to normal without medication. Although this approach isn’t realistic for everyone, focusing on healthy eating and being mindful of your body weight can play a major role in managing diabetes.

Medications

If lifestyle changes aren’t enough to control your blood sugar, your doctor will likely prescribe medication. Since type 2 diabetes tends to get worse over time, at some point you might need to use insulin to control your blood glucose levels. Many people with type 2 diabetes are prescribed multiple medications that work together to better control blood glucose levels.

Keep in mind that some diabetes medicines need to be taken at a certain time of day, such as before meals or with the first bite, to be effective. Ask your doctor or pharmacist about when to take your diabetes medications if you aren’t sure.

There are 10 classes of medications approved for treating type 2 diabetes. Most are taken by mouth, and others are injected. The most common classes of drugs prescribed for type 2 diabetes are highlighted below.

Type 2 Diabetes Pills

• Biguanides — Metformin, the most common drug in this class, works by decreasing glucose production in the liver and improving insulin sensitivity. Metformin is sold under brand names such as Glumetza.
• Sulfonylureas — These drugs work by increasing the amount of insulin released by the pancreas. Sulfonylureas include glimepiride (Amaryl) and glyburide (DiaBeta).
• Thiazolidinediones (TZDs) — These medications are believed to work by decreasing the amount of glucose released by the liver and making insulin more effective in muscle and fat tissues. Pioglitazone (Actos) is a common TZD. Note that rosiglitazone (Avandia) is rarely used due to cardiovascular risk concerns.
• Dipeptidyl peptidase 4 (DPP-4) inhibitors — These drugs help the body continue to make insulin. DPP-4 inhibitors include alogliptin (Nesina), linagliptin (Tradjenta), saxagliptin (Onglyza), and sitagliptin (Januvia).
• Sodium-glucose cotransporter-2 (SGLT2) inhibitors — These medications help the kidneys remove excess sugar through urine. Examples include canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance). Recent studies have shown that SGLT2 inhibitors offer significant cardiovascular and renal (kidney) benefits in addition to blood sugar control.

Injectable Medications

• Glucagon-like peptide 1 (GLP-1) receptor agonists — These drugs slow digestion and help lower blood sugar levels, which may also lead to weight loss. Examples include liraglutide (Victoza) and semaglutide (Ozempic).
• GIP/GLP-1 receptor agonists — In 2022, the U.S. Food and Drug Administration (FDA) approved tirzepatide (Mounjaro), the first drug in this new class. This medication has shown promising results in blood sugar control and weight loss.

What Is the Best Medicine for Type 2 Diabetes Without Side Effects?

Although all medications can have potential side effects, some are generally well tolerated. Since everyone’s diabetes care needs are unique, it’s essential to consult your doctor before starting or stopping any medications.

Metformin is often considered the first-line treatment for type 2 diabetes, as recommended by the American Diabetes Association. Combined with diet and exercise, metformin is effective for managing blood sugar and generally has a low risk of side effects.

Is There a Better Drug for Type 2 Diabetes Than Metformin?

If lifestyle changes and metformin alone don’t control your blood sugar, guidelines recommend adding a second medication or insulin. If this combination still doesn’t adequately control blood glucose, your doctor will likely prescribe additional medications.

Although metformin is highly effective for many people, other drug classes — such as SGLT2 inhibitors and GLP-1 receptor agonists — have shown promising benefits. These medications may offer additional protection for the heart and kidneys, and GLP-1 receptor agonists are especially helpful for weight management. However, the best treatment plan depends on your unique needs, so be sure to discuss medication options with your health care provider.

Combination Medications

For people on a complex treatment regimen for type 2 diabetes, combination medications — those that include drugs from more than one class — can be a convenient option. Taking one combination medication instead of multiple separate ones can simplify the routine and make it easier to remember daily doses. Examples of combination drugs include empagliflozin/metformin (Synjardy), glyburide/metformin (Glucovance), pioglitazone/metformin (Actoplus Met), and sitagliptin/metformin (Janumet).

Insulin

If lifestyle changes and medication don’t keep blood glucose levels in check, your doctor may recommend insulin therapy. Insulin is usually injected into the fatty tissue just under the skin (subcutaneous injection). It’s absorbed fastest when injected into the abdomen, but be sure to rotate injection sites to prevent lipodystrophy — small lumps that can form in the fat under the skin and affect how insulin is absorbed.

If your doctor prescribes insulin, they’ll work with you to calculate the doses and set up a schedule. As you use insulin over time, your doctor will help adjust the dosage to maximize its effectiveness.

There are several types of insulin, each with different timing and effects. Here’s an overview of the main kinds:

• Rapid-acting insulin — Taken before a meal, it begins working within about 15 minutes and is effective for one to two hours. Examples include insulin aspart (Fiasp, NovoLog), insulin lispro (Admelog, Humalog, Lyumjev), and insulin glulisine (Apidra).
• Regular or short-acting insulin — Also taken before meals, it starts working in about 30 minutes and lasts for three to six hours. Examples include insulin regular (Humulin R, Novolin R).
• Intermediate-acting insulin — Typically taken twice daily, it lasts for 12 to 18 hours. Examples include insulin isophane (Humulin N, Novolin N).
• Long-acting insulin — Usually taken once a day, it can work for up to 24 hours. Examples include insulin degludec (Tresiba), insulin detemir (Levemir), and insulin glargine (Basaglar, Lantus).
• Ultra long-acting insulin — Taken once a day, it lasts for about 36 hours or longer. An example is insulin glargine U-300 (Toujeo).
• Premixed insulin — This type combines short and longer-acting insulins for convenience. Common options include 75 percent neutral protamine lispro plus 25 percent insulin lispro (Humalog Mix 75/25) and 70 percent insulin aspart protamine plus 30 percent insulin aspart (NovoLog Mix 70/30).

There are several delivery methods for injectable insulin:

• Syringes — Available in various types, syringes differ in barrel size and needle gauge. Your doctor can help you choose the type that best meets your needs.
• Pens — These small, lightweight devices resemble large ink pens. Insulin pens come in disposable or durable (refillable) options, offering convenience and portability.
• Pumps — An insulin pump is a small, computerized device with a thin tube and needle inserted under the skin, typically in the abdomen. The pump mimics the body’s natural insulin release cycle by delivering insulin in two ways: a steady, continuous dose and an extra dose around mealtimes.

Insulin human (Afrezza), the only inhaled insulin product on the market, was introduced in the U.S. in 2015. This option provides rapid-acting insulin for those who prefer a needle-free delivery method.

Other Treatments for Type 2 Diabetes

Beyond lifestyle changes and medications, some people with type 2 diabetes may require other treatments, such as surgery, dialysis, or vaccinations, to maintain health.

Surgeries

In some cases, bariatric surgery may be recommended for people with obesity (high body weight) and type 2 diabetes to help with weight loss and potentially improve blood sugar control. Common types of bariatric surgery include:

• Gastric bypass surgery (Roux-en-Y)
• Adjustable gastric band, also known as laparoscopic adjustable gastric banding (LABG) or the lap-band
• Sleeve gastrectomy

To be eligible for bariatric surgery, most individuals need to have a body mass index (BMI) over 35 or a lower BMI with medical complications such as poorly controlled diabetes. Studies have shown that bariatric surgery can lead to improvement or even remission of diabetes in some people.

Amputation is sometimes a result of diabetic neuropathy (nerve damage), poor circulation, infections in people with type 2 diabetes, and poorly controlled blood glucose. According to the Centers for Disease Control and Prevention (CDC), about 80 percent of lower limb amputations in the U.S. can be attributed to diabetes or a complication of diabetes.

Although relatively uncommon, a kidney transplant may be an option for individuals with type 2 diabetes who have end-stage kidney disease. This surgery involves replacing a damaged kidney with a healthy one from a living or deceased donor. After the transplant, lifelong immunosuppressive medications are needed to prevent the body from rejecting the new kidney.

Dialysis

High blood glucose levels in type 2 diabetes can damage the kidneys over time, sometimes leading to kidney failure, when the kidneys can no longer function well enough to maintain health. For people with severe kidney damage, kidney replacement therapy, such as dialysis, may be necessary. Types of dialysis include:

• Hemodialysis — This process uses a machine, known as a dialyzer, to filter waste products from the blood, acting as an artificial kidney. You may receive hemodialysis at home or at a dialysis center, depending on treatment frequency.
• Peritoneal dialysis — In this type, the peritoneum (the tissue lining your abdomen) filters waste products from the blood. One advantage of peritoneal dialysis is that it’s done frequently, which helps prevent the buildup of fluid and waste that can occur with hemodialysis.

Vaccinations

People with type 2 diabetes should stay up to date with recommended vaccinations based on age and health conditions. These may include flu shots, as well as pneumococcal, Tdap (tetanus, diphtheria, and acellular pertussis), hepatitis B, herpes zoster (shingles), and COVID-19 vaccinations. Ask your doctor what vaccinations you should receive and how often you should get them.

Future Treatments for Diabetes Type 2

Exciting new research on diabetes type 2 is underway, exploring promising treatments such as the following:

• Artificial pancreas — This advanced system can continuously monitor blood sugar and deliver insulin as needed, helping to maintain stable blood sugar levels with minimal manual input.
• Gene and stem cell therapy — Researchers are exploring ways to modify genes to improve insulin production or sensitivity and possibly restore insulin-producing cells in the pancreas, which could transform diabetes management.
• Gut microbiome treatments — Modifying gut bacteria with prebiotics and probiotics might help improve glucose metabolism, potentially offering a new approach to managing blood sugar levels.

Complementary, Alternative, and Natural Treatments

Some people with type 2 diabetes incorporate natural or holistic treatments and report relief from certain symptoms. However, these should never replace prescribed medications and should always be discussed with a health care provider, as some may interact with medications and cause harmful side effects or reduce their effectiveness.

• Acupuncture — This traditional medicine involves inserting small needles into specific parts of the body, which may help ease pain caused by nerve damage. The needles stimulate the brain to release chemicals that can reduce pain sensitivity. More research is needed to determine the benefits of acupuncture, but this practice shows promise in treating diabetes-related nerve pain.
• Herbal supplements — Certain supplements, such as alpha-lipoic acid, chromium, cinnamon, and ginseng, have shown potential benefits for blood sugar control. However, more research is needed to confirm these effects, and these supplements may interact with medications.

Although type 2 diabetes is a disease that tends to get worse over time, with proper management, many people lead healthy, active lives. Always work closely with your health care team to find the best treatment plan for you.

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